Purpose Breast cancer is the most common cancer among women worldwide and is the leading cause of cancer death among women in low- and middle-income countries, including Ethiopia. Availability of both basic and comprehensive services in all frontline health care facilities is important for cancer control. Whereas women are equally affected in both urban and rural settings, most services are present in urban areas. We assessed health system readiness for breast cancer prevention and treatment in selected hospitals in Western Ethiopia. Methods A total of seven rural hospitals in Western Ethiopia were assessed for availability of comprehensive breast cancer services. A checklist prepared on the basis of breast care prevention and control standards for low-resource settings—recommended by the 2007 Global Summit of Breast Health Global Initiative—was used for the assessment. Data were descriptively analyzed and discussed. Results Whereas cancer incidence and mortality rates are increasing in Ethiopia and other sub-Saharan countries, there is currently no competent health system available that is adequately equipped to meet this challenge. In Ethiopia, the majority of systemic oncologic treatment is administered at the Addis Ababa University Hospital in the capital city, and the majority of patients are referred to this center, which, for the average patient, is more than 500 km away. There are relatively large numbers of health professionals in health facilities in Western Ethiopia, but a critical absence of pathologists and oncologists. Basic diagnostic services, such as ultrasonography and X-ray, were found to be available in most hospitals; however, there were major gaps in cytologic and pathologic services. The nearest referral centers for pathology and additional breast cancer treatment required travelling significant distances; there were no systemic breast cancer treatment and palliative services available in Western Ethiopia. Conclusion Our study revealed that all health facilities lack a comprehensive package of breast cancer diagnosis and treatment services. The lack of implemented comprehensive breast care prevention, diagnosis, treatment, and referral services is representative of most other rural settings in Ethiopia. This calls for a nationally coordinated effort in defining and implementing breast cancer prevention and control standards to realize the national cancer control plan. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Eva Kantelhardt Travel, Accommodations, Expenses: Daiichi Sankyo Oncology Europe

Introduction In Ethiopia, breast cancer is the leading cause of cancer among women. Little is known about the duration of disease and symptoms of patients who died from breast cancer in rural Ethiopia. The objective of this study was to assess breast cancer mortality with a particular focus on the self-reported duration of illness including suffering of symptoms, and need for medical care. Methods The cause of death was determined among randomly selected Ethiopian women residing in western Ethiopia. A modified standard verbal autopsy (VA) questionnaire was completed by women whose sisters had died. The questionnaires were reviewed by two independent local physicians to assign a cause of death. We analyzed pattern of cause of deaths, duration of suffering, symptoms, and treatment received. Result In our study, the age at death was very similar to other population-based data from Ethiopia. We found 32% of 788 deaths were caused by communicable diseases, 12.1% by neoplasms, and 9.4% by pregnancy/maternal mortality. Breast cancer was the second leading neoplasm, responsible for 21 (2.7%) of all deaths (95% CI 1.5–3.7%), and was among the top five causes of non-communicable deaths. The median age of breast cancer death was 37 years, younger than for other causes of death. The median duration of illness with breast cancer was around 1 year. This was substantially more compared to the duration of infectious diseases, but less than the duration of reproductive neoplasms, diabetes, and epilepsy. Discussion/conclusion Breast cancer deaths are common causes of death in women of rural Ethiopia. When assessing the total duration of illness according to specific causes of death, breast and other cancers accounted for a large share of the burden. This has practical implications and highlights the need for palliative care for cancer patients. Substantial efforts are necessary to improve early detection and treatment for breast cancer to reduce premature death in women.

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